Federal and state regulations mandate that restrained residents of long term care (LTC) facilities be released and exercised for at least ten minutes every two hours. Actual compliance by nurses aides in nursing homes is low, but records usually show 100% compliance. Chairbound restrained nursing home residents are usually cognitively impaired and are not effective self advocates. We will enhance an existing low cost, thigh worn, body orientation monitor so that it can record when restrained seated frail elderly are released and allowed to or aided in standing. It will also record the duration of release and we will do research to see if it can be made to distinguish between different types of release activities. If seated restrained LTC residents are not regularly released for repositioning and exercise, they are at very high risk for developing characteristic pressure ulcers. In an environment where care giving is shared by many, without means to rapidly and continuously monitor the process of care giving, meaningful feedback and discussion on ways to improve that care is hampered. We are developing a product that may help reduce the incidence of pressure ulcers on restrained residents of long term care facilities, that helps nurses better manage their aides, and that can be used to effectively investigate and then justify the costs of reliable restraint release and regular resident repositioning. Proposed commercial applications: There are major discrepancies between the actual care delivered by nurses aides and nursing home records that indicate regular restraint release and resident exercise. Our inexpensive wearable monitors will the first practical system to permit nursing homes to institute effective quality assurance programs on non-ambulatory resident restraint release and exercise, and for 3rd party payers to verify mandated care is delivered.